title: Tocilizumab in refractory Takayasu arteritis: a case series and updated literature review.
abstract: OBJECTIVE
  The aim of this study is to analyze the efficacy and tolerance of tocilizumab in patients with Takayasu arteritis (TA).
  
  
  METHODS
  We retrospectively studied patients with TA (ACR and/or Ishikawa's criteria): 5 French multicenter cases and 39 from the literature. Clinical, biological, radiological disease activity and treatment were analyzed before tocilizumab, during the follow-up and at the last available visit.
  
  
  RESULTS
  Forty-four patients (median age 26years [3-65];) were included in the present study: 5 patients from the 3 French university hospitals and 39 cases from the literature review. Median follow-up after initiation of tocilizumab was 15months [8-33]. Clinical and biological activities significantly decreased within 3months, similarly to steroid amount (from 15mg/day [5-75] at baseline to 10mg/day [2-30] at 6months; p<0.05) and steroid-dependence rate. Even radiological activity did not significantly decrease at 6months, significant decrease of arterial FDG uptake was noted at 6months. Median duration of tocilizumab treatment was 9months [3-180]. At the last visit, tocilizumab was continued in 17/32 patients (53%), and was discontinued in the 15 remaining cases because of the remission (n=5), relapse (n=3), persistent radiological activity (n=3), cutaneous rash (n=2), severe infection (n=1) and lacking of care welfare system (n=1). No death related to tocilizumab treatment was noted.
  
  
  CONCLUSIONS
  This study show the efficacy of tocilizumab in terms of clinical, biological and radiological response, as well as steroid-sparing agent. Only well-designed studies could definitely address the efficacy of tocilizumab in TA.
authors.affiliation: Service de médecine interne, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140 Bondy, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Abisror
authors.forename: Arsene
authors.initials: A
authors.lastname: Mekinian
authors.forename: Christian
authors.initials: C
authors.lastname: Lavigne
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Vandenhende
authors.forename: Michael
authors.initials: M
authors.lastname: Soussan
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000293:Adolescent; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013625:Takayasu Arteritis / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D013256:Steroids; C502936:tocilizumab
keywords: Takayasu arteritis; Tocilizumab; Treatment